VOLUNTEER SERVICES. Salutations

Transcription

1 VOLUNTEER SERVICES Salutations Thank you for your recent interest in the volunteer program at Pomona Valley Hospital Medical Center. Volunteer services at PVHMC encompass a variety of experiences for people wishing to help their community. All services are designed to provide the highest level of customer satisfaction to the patients, visitors, and staff while fulfilling the needs of our dedicated volunteers. Included in this application packet is information about our Auxiliary, our current wish list for new volunteers and our newsletter. We hope you enjoy learning more about us. To start on the road to becoming a PVHMC volunteer, interested persons like yourself are asked to come in for an interview with the Director of Volunteer Services. Interview times are varied and appointments are required. You can make your interview appointment by calling the Volunteer Office at (909) At PVHMC our general request for a volunteer is to come in once a week for 4 hours. While this is the average schedule, some volunteers give more time and some volunteer only once every other week. With various volunteer opportunities available, we hope to find just the right service to meet your needs and the needs of the Hospital as well. While we will try our best, we cannot always guarantee placement as a volunteer. Areas that volunteers assist in are not considered job training or work experience towards paid positions. I look forward to hearing from you and meeting with you soon. Please read over the enclosed materials and complete the volunteer application. If you have any questions please don t hesitate to call. If you are currently a high school or college student, the student volunteer programs require a different application and process. Please call the Volunteer Office if you are interested in the student volunteer programs. Stacy L. Mittelstaedt Director of Volunteer Services How to get started: 1. Complete the volunteer application 2. Obtain two (2) letters of recommendation/reference (One should be from a professional and neither should be from a family member.) 3. Call the Volunteer Office at (909) to make an interview appointment 4. Bring application and letters of recommendation to interview 1798 North Garey Avenue Pomona, CA (909)

2 VOLUNTEER APPLICATION GENERAL INFORMATION LAST NAME FIRST MIDDLE DATE HOME ADDRESS STREET APT. CITY STATE ZIP CODE HOME PHONE MESSAGE/CELL PHONE ( ) ( ) EMERGENCY NOTIFICATION 1 PERSON TO CONTACT: RELATIONSHIP: EMERGENCY NOTIFICATION 2 PERSON TO CONTACT: RELATIONSHIP: HOME PHONE: WORK: HOME PHONE: WORK: HOW WERE YOU REFERRED TO US: ADVERTISEMENT: VOLUNTEER: OTHER: VOLUNTEER AVAILABILITY & INTERESTS DAYS & TIMES AVAILABLE: (PLEASE CIRCLE) SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY AM AFT EVE AM AFT EVE AM AFT EVE AM AFT EVE AM AFT EVE AM AFT EVE AM AFT EVE ARE THERE ANY DAYS AND/OR HOURS THAT YOU ARE NOT AVAILABLE TO VOLUNTEER? WHY DO YOU WANT TO BE A VOLUNTEER? HOW DID YOU BECOME INTERESTED IN VOLUNTEERING AT PVHMC? PLEASE LIST PREVIOUS VOLUNTEER EXPERIENCE: Skills Bank Information The Auxiliary and Volunteer Office frequently host special events and programs for the Hospital as well as being asked to provide special volunteer assistance throughout the year. Please circle any items you may be willing to help with: Activities Planning Answering Office Phones Baking Bookkeeping Buying Calligraphy Registration for Events Clerical Computer Leadership Musical Instrument Newsletter Office Machines Photography Poster Lettering Public Speaking Publicity Quilting Crafts Decorating Display Filing Floral Arrangements Fund Raising Graphic Arts Knitting/Crocheting Sewing Stuffing Envelopes Telephoning Tour Guide Typing Video Taping I Could Occasionally Help With: Addressing, Labeling and Stuffing Envelopes Answering Phones at Lunchtime Special Projects and Events at the Hospital (Planning committees, event set-up, registration, etc.) Languages Spoken (Other than English):

3 CURRENT EMPLOYER (IF RETIRED, PLEASE INDICATE) EMPLOYMENT INFORMATION PHONE NUMBER BASIC INFORMATION HAVE YOU PREVIOUSLY BEEN EMPLOYED BY, VOLUNTEERED FOR OR WORKED THROUGH ANOTHER AGENCY AT POMONA VALLEY HOSPITAL MEDICAL CENTER? YES NO POSITION FROM TO YOUR NAME IF DIFFERENT FROM APPLICATION HAVE YOU EVER APPLIED FOR A POSITION WITH P.V.H.M.C. BEFORE? YES NO POSITION(S) DATE OF LAST APPLICATION FAMILY DOCTOR: PHONE: DO YOU HAVE ANY PHYSICAL LIMITATIONS TO BE CONSIDERED FOR VOLUNTEER PLACEMENT: YES NO IF YES, PLEASE EXPLAIN BRIEFLY: DO YOU REQUIRE ANY SPECIAL ACCOMMODATIONS? YES NO IF YES PLEASE DESCRIBE: PLEASE ANSWER ACCURATELY. WE CONDUCT FULL BACKGROUND CHECKS ON ALL CANDIDATES. Have you ever been convicted of a felony or misdemeanor? YES NO If yes, please give date, place of conviction, and explain circumstances. Please be aware that a criminal record does not automatically disqualify you from volunteer work at PVHMC. Whether or not formally charged or convicted, have you ever been arrested for a drug or sex related offense? YES NO. If yes, please give date, place of conviction, and explain circumstances. Please be aware that a criminal record does not automatically disqualify you from volunteer work at PVHMC. PLEASE READ CAREFULLY. VOLUNTEER S CERTIFICATION, AGREEMENT AND NOTICE. I certify that all information in this application is true and complete. I understand that any false information or omission may disqualify me from further consideration for volunteer service and may result in my dismissal, if discovered, at a later date. I understand that Pomona Valley Hospital Medical Center requires certain information both personal and professional from me to evaluate my qualifications for volunteer service. I understand that in review of my application, a background investigation may be conducted. I authorize and release all past and present employers, personal references any other organization to answer all questions asked concerning my previous employment and/or volunteer record, ability, character, emotional background, military service, criminal and, if applicable, driving history. In consideration of my application for volunteer service, I authorize Pomona Valley Hospital Medical Center and all associated entities, to conduct an investigation and release Pomona Valley Hospital Medical Center of responsibility for this investigation, which may include, but is not limited to, the performance of medical examinations, drug screening, reference verification, driving history, military service, and criminal background check which may be in the files of any Federal, state, or local criminal justice agency. I understand that any information requested is for the sole purpose of gathering information accurately for use in the above-mentioned volunteer and background investigation. I have read and understand the above, and by my signature consent to these statements. Applicant s Name (Please Print) Applicant s Signature Today s Date

4 Become a Volunteer Volunteers complement the professional services in both direct patient care and ancillary areas. While volunteers do not perform the duties of staff, their caring, compassion and dedication to service enhance the daily operations of our Hospital as well as the lives of our patients and their families. Areas of service for which we currently seeking new volunteers include but are not limited to: Gift Shop Dismissal Volunteers (Wheelchair Transport) Shuttle Drivers Process to Become a Volunteer Main Lobby Information Desk Cancer Care Center Lobby Ambassadors Critical Care/ICU Information Desk Complete the PVHMC Volunteer Application form. Please know that we are unable to place every applicant. The Department of Volunteer Services reserves the right to amend the specifications of its programs at any time. Please review this section before calling for an interview appointment. Obtain two letters of recommendation/reference. Letters from family members are not acceptable. Letters from businesses/professionals must be on letterhead, letters from friends should have an address or phone number for verification. Call to make an appointment for a personal interview with the Director of Volunteer Services. Contact the Volunteer Office at (909) Bring to interview: o Volunteer Application Form - Completed o Request for Information / Background Check - Completed o Two letters of recommendation/reference Upon approval, prospective volunteers will receive an invitation to Volunteer Orientation. Attend a 4-hour orientation. Held once per month, evening and day schedules. o After attending orientation, prospective volunteers will: Complete the required two step tuberculosis (TB ) screening, complete the necessary health questionnaires and be cleared by the Occupation Health office at PVHMC. Be accepted after clearance is received from criminal background check. Commit to a weekly, bi-weekly or monthly schedule. Purchase a volunteer uniform. Available in the Volunteer Office, costs are $25 or less. Commit to a six-week assignment as an Ambassador Volunteer to learn your way around the Hospital, meet other volunteers and experience different areas that volunteers are assigned to. Be placed in a volunteer service of your choice that coincides with the needs of the Hospital and complete the required service task list and assessment for that area. Be emotionally and physically healthy when you come into volunteer. Wear volunteer ID Badge at all times when volunteering. Abide by all hospital rules and regulations when on duty as a volunteer. Have fun.

5 Volunteer Applicant Notification / Release of Information The purpose of this form is to notify you that a Consumer Report and/or an Investigative Consumer Report will be conducted on you in the course of consideration for a volunteer position. This report may include information relating to your character, general reputation, personal characteristics, or mode of living, and is being provided by Pre-employ.com, Inc PO Box Redding, CA Phone I hereby authorize your company or any agent of your company to contact any and all corporations, former employers, credit agencies, educational institutions, law enforcement agencies, city, state, county, and federal courts and military services to release information about my background including, but not limited to, information about my employment, education, consumer credit history, driving record, criminal record, and general public records history to the person or company with which this form has been filed. This releases the aforesaid parties from any liability and responsibility for collecting the above information. I understand I have the right to obtain a free copy of this consumer report if; (1) Any adverse action/decision is made based on the information in the consumer report, & (2) If the request is made in writing within 60 days of the adverse action. If an Investigative consumer Report is conducted, I will be notified in writing with in three days from request of said report. I believe to the best of my knowledge that all information I have provided is accurate true and correct and that I fully understand the terms of this release. Please write clearly in Black Ink only. Name (Last) (First) (Middle) List any other name used in the last 7 years (including maiden name, hyphenated name, etc.) Date of birth / / Social Security Number - - Drivers License # State Phone # (Day) ( ) - Professional License Held State Lic.# List your current mailing address as well as any other cities or towns you have lived in the past 7 years: Street or PO# City State Zip Your Signature Today's Date / / California residents initial here if you wish a free copy of this report mailed to the address you supplied above: ***APPLICANT DO NOT WRITE BELOW THIS LINE*** FAX TO: (888) TO BE FILLED OUT BY COMPANY REQUESTING INFORMATION: Company Name: _PVHMC VOLUNTEERS Please start our standard background check (ignore boxes below) Or select from the following: Criminal History Civil History Credit Report Social Security Verification Driving Report Education/Degree Verification Reference Check National Wants & Warrants Professional License Verification Previous Employer Verification O.I.G name search While the information contained in the reports provided has been obtained from public records data sources deemed reliable, its accuracy cannot be guaranteed due to potential human error in the actual recording of the record. Since this information is not owned by Pre-employ.com, Inc., and since public records data on any one individual, group of individuals, company, or companies can be contained in more than one repository Pre-employ.com, Inc. can only rely on its accuracy from the public records data sources presently available at the time of the search. This information is furnished for your exclusive use and accepted by you without any liability on the part of Pre-employ.com, Inc. its sources, officers, agents or employees. Furthermore you agree to indemnify Pre-employ.com, Inc., its sources, agents, and employees of any liability for the use of this information and shall agree that the right to obtain and the purpose for this information, for your exclusive use, is fully within the appropriate law or laws which apply to the permissible purpose of retrieving background information on an individuals criminal records history, credit history and / or workers compensation claim history.